780株儿童血培养阳性菌株分布及耐药性分析

目的：了解我院儿童血流感染病原菌的分布及耐药性，为临床合理使用抗菌药物提供参考。方法：对2010年1月至2012年12月我院儿科病房送检的血培养阳性菌株及药敏结果进行回顾性分析。结果：780株血培养阳性病原菌主要来自重症监护病房小于1岁的婴幼儿及新生儿，其中革兰阳性菌占67．9％，主要为凝固酶阴性葡萄球菌（CNS），对青霉素、红霉素、复方磺胺甲嚼唑耐药率〉80％，耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）、肠球菌耐药严重，未发现万古霉素耐药菌株。革兰阴性菌前4位菌株为肺炎克雷伯菌、嗜麦芽窄食单胞菌、大肠埃希菌和铜绿假单胞菌，除铜绿假单胞菌耐药率较低外，其余菌株对常用抗菌药物耐药率均较高。结论：儿童败血症主要见于小婴儿，多数来自重症监护病区，以革兰阳性菌为主，其耐药形势严峻，应引起-临床医师高度重视。

Distribution and Drug Resistance of 780 Isolates from Positive Blood Culture Samples of Pediatric Patients

Objective： To investigate the distribution of pathogenic bacteria in blood culture of pediatric patients and observe the antibiotic resistance of these bacteria in order to provide the reference for clinical use of antibiotics. Methods： The positive blood culture samples were taken from our pediatric wards in January 2010 to December 2012, and drug susceptibility was analyzed retrospectively. Results： The 780 positive blood culture samples were mainly found in infants less than one year old and neonates in intensive care unit. Gram-positive bacteria was accounted for 67.9% ; the most common Gram-positive bacteria was coagulase negative staphylococcus （CNS）; the drug resistance rates to penicillin, erythromycin and sulfamethoxazole trimethoprim were more than 80%. The drug resistance rates of MRSA, MRCNS and Enteroeoccus were very high; no strains of Gram-positive bacteria were resistant to vancomyein. The most common four strains of Gram-negative bacteria were Pneumonia klebsiella bacteria, Stenotrophomonas maltophilia, Escherochia coli and Pseudomonas aeruginosa. Except Pseudomonas aeruginosa, the drug resistance rate of the rest strains were high to commonly used antibiotics. Conclusions： Septicemia mainly occurred in infants and neonates. Most of patients were in the intensive care ward. Gram-positive bacteria were the most common pathogen, and the situation of antibiotic resistance was serious.